Under the Skin: Exploring Female Skin Issues

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Feel like you’re in a losing battle against acne, dry skin, and blotchiness? You’re not alone. Writer Rachel Debling explores a plethora of common female skin issues, and puts her own skin under a magnifying glass to get to the root of it all.

After waiting for what seemed like hours in the sterile, impersonal examination room, I couldn’t help but hold my breath as the physician finally opened the door to greet me. I had expended so much energy over the previous five months trying to hope away the infection that had crept onto my forehead (by this point the imposing size of a halved golf ball) that I was almost relieved by the doctor’s initial, though blunt, prognosis.
“Well,” he said, crouching until our faces were mere inches apart and focusing his gaze squarely at the spot above my left brow. “That’s quite the abscess.”
Thank you, Doctor Obvious.
Like many women my age – a proud 35 – I had hoped that my adolescent skin troubles would dissipate with age, leaving me with at least a decade of luminous, dewy skin until the inevitable wrinkles settled in.
As it turns out, my skin had different plans.
From the aforementioned zit gone wrong to a dark patch that appeared over my upper lip (decidedly different from the fuzzy patch I have been religiously tweezing every week), my female skin issues have increased steadily in severity over the past few years – and I know I’m not alone. Are hormonal changes to blame? Do I need to tweak my diet? Is my workout schedule at the core?
So I turned to the experts for some insight into some of the most burning (literally and figuratively) dermis q’s I could think of, and walked away with what I feel is a brighter, clearer picture of what the hell is going on.

Skin SOS: Dry Flaky Skin

When I was posing my questions to Prystowsky, it was the dead of winter and I was tired of another season of scaly elbows and bleeding knuckles.
For many, this unfortunate, female skin issue isn’t relegated to the colder months. And flakes and cracks in some of the most offending areas (mostly around joints, such as your heels) may be indicative of a more serious issue, such as a persistent fungus or type 2 diabetes, and require the intervention of a doctor. However, dry skin is more often related to lack of hydration – but not in the way you may think.
The aptly described ‘horny layer’ of skin is actually comprised of dead skin cells and tends to crack and peel due to a loss of elasticity when it dries out, notes Prystowsky. Even worse, this cracking will expose the living layer of skin cells, the epidermis, causing its cells to die. But the destruction doesn’t stop there: below the epidermis is the dermis, and the dermis doesn’t appreciate a lack of hydration any more than its more superior layers. It responds – as many of us do when provoked – by becoming red and irritated.
“The key to keeping the stratum corneum well hydrated is to prevent evaporation of the moisture out of the cells and into the air,” Prystowsky says. Evaporation-preventing lotions and salves such as Vaseline are among Prystowsky’s recommendations. Though heavy creams can be helpful, they’re of temporary help.
Unfortunately, and despite what many purported health experts will tell you, simply drinking more water isn’t the way to supple, vibrant skin. The best thing to do is trust your gut. “Drink enough water to satisfy your thirst,” Prystowsky advises. Instead, if you are victim of the occasional flaky patch, using a non-irritating, soap and fragrance-free cleanser can keep your skin looking smooth and polished. And when you go to rinse, watch the temperature – a warm, quick wash will be gentler on your sensitive skin than a steaming bath or super hot shower.

Image: Shutterstock

Skin SOS: Dark Spots and Patches:

Over the past few years, I have jumped from one birth control method to the next like a cat on a hot tin roof. It began when, in an attempt to distance myself from taking a pill every day, as I had been since I was 16, I looked into alternative methods.
After a short period of time on a hormonal IUD, I developed a peculiar dark streak of skin above my mouth like a moustache, which persisted despite throwing dozens of expensive creams and serums at the problem. After a year of trying everything I could think of, I ditched the IUD and opted for another method containing a different mix of hormones. (It didn’t help, and I abandoned the BC ship altogether.)
When I described my situation (which has thankfully cleared up in the months following the ordeal) to Prystowsky, she provided cautious confirmation of what I had suspected. “While I can’t give you a diagnosis, it may have been a melasma reaction,” she wrote me. My research had shown that many of the same hormones that circulate the body during pregnancy – most notably progesterone – lead to melasma, the dark splotchy patches usually found on the face that are commonly known as ‘the mask of pregnancy.’ This female skin issue is exacerbated with UV light, making exposed areas, such as the upper lip, especially vulnerable —another great reminder of the importance of sun protection.

Skin SOS: Out of Control Zits

A 2018 study of more than 1,100 dermatology clinic patients found that female skin issue patients were more likely to complain of acne, with nearly 30 percent of those people experiencing ‘late-onset’ acne—acne that flared up later in life—which is exactly what I had been experiencing.
The American Academy of Dermatology (AAD) names several possible catalysts for later-in-life acne, including stress, family history, and fluctuating hormone levels. Unfortunately, pimples associated with this variation of the condition may be bigger and deeper than those experienced during one’s teen years. As in my case, it can sometimes develop into something more dangerous than a simple pus-filled zit.
“Once an acne lesion gets sufficiently inflamed the outer skin layer breaks down and there is a small wound,” Prystowsky explains. Patients then may be tempted to pop or poke the offending pimple (guilty) and, while there is a certain satisfaction in a successful squeeze, it opens your skin up to trouble. “These actions increase the risk of the pimple getting secondarily infected with staph or even MRSA (a germ resistant to common antibiotics) which can lead to abscess formation,” adds Prystowsky. Oral antibiotics, such as the ones prescribed to me several weeks ago (spoiler alert: they worked), are usually required to remedy the situation
The best ways to avoid breakouts will vary from person to person, and may require the help of a dermatologist, but there are certain basics you should follow throughout every stage of life: avoid going to bed with makeup on, restrain from touching your face, and eat fewer dairy- and carbohydrate-rich foods, which has been shown to trigger acne in certain portions
of the population.

Skin SOS: Body Rashes:

One of the worst side effects of exercise is not sweat, it’s what that sweat can cause; especially when it pools around crevices and cracks in your skin, such as around the straps of your bra, armpits, navel and groin.
“Usually the chafing is from rubbing skin that is over hydrated from sweat,” explains Prystowsky. “I recommend changing the outfit or rotating different styles to decrease repetitive rubbing in the same skin areas.”
Less easy to cure, exercise-induced urticaria manifests itself as hives or welts on the body and is sometimes accompanied by other symptoms such as a stomach or headache. And though doctors are still debating what exactly causes it, the best and only way to treat it is to stop doing what had started it in the first place (you guessed it, exercise). It’s a condition that seems to be associated with sweat and moisture around the skin, so choosing the method and location of exercise may help a sufferer avoid symptoms; for example, avoiding outdoor exercise when temperatures swell.

Though I would by no means claim that my skin now has the glowing, dewy quality my teenage self had always dreamed of, I can say I’ve walked away from my months of skin struggles with a greater appreciation for my ‘normal’ complexion. Sure, it’s a little spotty, and certainly erratic in its response to stimuli, but its propensity for oil production has kept me relatively wrinkle-free for close to four decades. Plus, I no longer have an infection nearing the point of sepsis just inches from my brain, and I think you’ll agree I can consider that the biggest win of all.

Being Proactive;

You may have heard it’s never too early to start skin treatments such as serums and salves. However, other, more intense therapies that are applied in a doctor’s office setting should be approached with caution. Lighter skinned patients may benefit from adding peels and lasers to their skincare regimen in their twenties and thirties, says Prystowsky. On the other hand, those with tanned skin or those of Asian descent may not require the extra help until well into their forties or fifties, and patients with African or Indian heritage may never need these types of stronger treatments. Of course, every case is different and your family history and therefore gene expression play a huge role in how your skin will develop over the years. It’s always best to lean on the advice of your doctor when trying to determine what is right for you and your complexion.

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